Peer Review

See also

The American Academy of Family Physicians supports effective peer review as an essential part of improving the quality of health care delivery. The membership is encouraged to actively participate in peer review programs to assure the use of high quality, patient-oriented evidence and sensitivity to community needs and practices. In addition, family physician participation will allow appropriate peer review for other family physicians.

In order for meaningful peer review to take place, adherence to the following concepts is essential:

The primary goal of peer review should reflect enhancing the quality of care for patients. Nonetheless, peer review will increasingly address issues of value driven care. Physicians should be the leader of these conversations.

Clinical policies for patient care should be established by practicing physicians based upon the best patient-oriented evidence available balanced with sensitivity to local needs and expectations.

Physician departure from clinical policies (e.g. clinical guidelines) should not be interpreted as a prior breach of good medical practice. Patient preference, the availability of services, and the weighing of individual risks and benefits may substantially influence management. Physicians should have access to the full rationale of peer decisions and opportunity for rebuttal if a negative conclusion is reached.

Peer review should assess the quality of care rendered. Peer review should be performed by a physician with similar qualifications to those of the physician being reviewed.

Criteria for care (e.g., hospital admission, transfer, or alternative care site delivery) should reflect severity of illness, social factors, caregiver burden, access to services and the particular circumstances of each patient.

Utilization review provided by a physician should be considered the most valid determiner of the correct diagnostic category. Physician peers should determine the appropriateness of care recognizing the many factors influencing decision-making.

The end product of peer review should be improvement of patient care through physician education and health system improvement. The conduct and process of peer review should seek to identify potential systematic improvements that the organization could implement to reduce the chances of mistakes or adverse events in the future.

In the public interest, peer review by medical staffs, medical societies, medical groups, health plans, and other entities should be confidential, protected, and not subject to disclosure or discovery, but the evidence and clinical decision making used in developing peer review decisions should be transparent and open to scrutiny. There should be the opportunity to provide further information and rebuttal to peer review outcomes. (1988) (2016 COD)